Int. J. Pharm. Sci. Rev. Res., 29(1), November December 2014; Article No.

. 56, Pages: 309-313 ISSN 0976 044X

Research Article

Hypertension as a Risk Factor of Hearing Loss

1 1 1 1 1 1 2
Tapaswani Mishra *, Kiran Dukhu , Dipti Mohapatra , Manasi Behera , Nibedita Priyadarsini , Priyambada Panda , Mahesh C. Sahu
1
Department of Physiology, IMS and Sum Hospital, K8, KalingaNagara, Siksha O Anusandhan University, Bhubaneswar, Odisha, India.
2
Central Research Laboratory, IMS and Sum Hospital, K8, KalingaNagara, Siksha O Anusandhan University, Bhubaneswar, Odisha, India.
*Corresponding authors E-mail: neetho@yahoo.com

Accepted on: 20-09-2014; Finalized on: 31-10-2014.

ABSTRACT
Hearing loss is a factor that affects the quality of life of people and it may make oral language receiving difficult. Studies confirm that
hearing changes may derive from arterial hypertension. So the study was undertaken to evaluate hypertension as a risk factor of
hearing loss. The study was carried out in the Department of Physiology in collaboration with the Department of ENT and
Department of Medicne, IMS and SUM Hospital, Bhubaneswar, Odisha, India. In this study, 150 cases and 150 controls groups were
taken both genders aged 45-64 years. Hypertension was verified through blood pressure readings by sphygmomanometer, and by
systematized questionnaire about hypertension and use of medication for hypertension. Hearing loss was assessed through pure
tone audiometry. Only sensory neural deafness was taken. Statistical analysis was made. There is significant risk factor of hearing
loss because of hypertension. Hearing loss population under study suggests that hypertension is an accelerating factor of
degeneration of the hearing apparatus. By this study we can prevent hearing loss by early detection of hypertension and make an
individual lead a normal social life.
Keywords: Hypertension, Hearing loss, Pure tone audiometer, Risk factor.

INTRODUCTION Katz2 says that all living cells in the human body depend
on proper supply of oxygen and nutrients in order to

H earing impairment affects every fifth adult

worldwide. The hearing loss (HL) is a factor that
irrespective of the degree of commitment affects
the quality of life of the people and when acquired in
adult, it appears gradually and may make the oral
maintain their function and such supply depend on
functional and structural integrity of the heart and blood
vessels. Hypertension is most common vascular disorder,
may facilitate structural changes in the heart and blood
vessels. High blood pressure in vascular system may cause
language receiving difficult. According to data from ASHA
inner ear hemorrhage, which may cause progressive or
(American Speech- Language- Hearing Association)1 there
sudden hearing loss. This circulatory system pathology
are currently 28 million individuals in USA with some type
may directly affect hearing in a number of ways. One of
of hearing loss and 80 % of those are irreversible cases.
the vascular pathophysiological mechanisms described is
These data also shows that 4.6% of the individuals
the increase in blood viscosity, which reduces capillary
between 18 and 44 years have hearing loss while 14% of
blood flow and ends up reducing oxygen transport,
the middle aged individuals between 45 and 64 years and
causing hearing complaints and hearing loss in patients.
54% of population above 65 years have some hearing
Moreover, arterial hypertension may cause ionic changes
loss. This is due to number of factors, such as intense or
in the cell potentials, thus causing hearing loss. Studies
continuous noise exposure, inhalation of toxic
confirmed that hearing changes may derive from systemic
substances, ingestion of ototoxic drugs, metabolic and
arterial hypertension (SAH) and a few diseases are
circulatory alteration, infections, different types of
responsible for such frequent complications such as those
injuries and genetic inheritance. In the adult population
arising out of arterial hypertension: cerebro vascular
studies confirmed that HL starts at about 30 years of age
accident, cardiac, renal, and peripheral vascular
and increases progressively along the years, although
insufficiency. Hypertension is taken as a silent disease for
there is resemblance in the audiologic configuration
it doesnt present any symptom. However some people
between men and women, men are affected earlier and
present headache, dizziness, tinnitus, chest pain and
more intensely than women. The hearing system
weakness, which may be alert signals. The association
affection may cause psychosocial effect, amongst which
between tinnitus and hearing loss has already been fully
low self-esteem, isolation, depression and irritability and
described. According to literature 85% to 96% of the
these problems interfere with the quality of life of
patient with tinnitus has some degree of hearing loss and
individuals.
the prevalence of tinnitus increases along the aging years.
However it is known that metabolic changes, such as The results attained with the present research project will
systemic arterial hypertension (SAH) is present in adults certainly serve as basis for a greater integration between
and may be empowered by the presence of hearing loss cardiologist, nephrologist, otorhinolaryngologys, speech
or vice versa. therapist and other health care professionals involved
with arterial hypertension and hearing loss care, bringing
International Journal of Pharmaceutical Sciences Review and Research
Available online at www.globalresearchonline.net 309
Copyright protected. Unauthorised republication, reproduction, distribution, dissemination and copying of this document in whole or in part is strictly prohibited. Copyright pro
Int. J. Pharm. Sci. Rev. Res., 29(1), November December 2014; Article No. 56, Pages: 309-313 ISSN 0976 044X

for the professionals involved in order to improve quality RESULTS

of care in therapy and rehabilitation of these patients.
A total of 150 test cases and 150 control cases were
MATERIALS AND METHODS studied among them 83(55.7%) were male and 67(44.3%)
were female. In the control group 76(50.7%) and the
Hearing loss with hypertension patients were studied in
numbers of females among the control group were
the Department of Physiology, in collaboration with the
74(49.3%). There were slightly more number of males
Department of ENT and the Department of Medicine IMS
than the number of females in the control group.
and SUM Hospital, Bhubaneswar, in the period of June
2011 to July 2013. There were 150 cases and 150 control It was found that 88 (58.7%) of the individuals had both
group taken for the study. Patents were included in the hearing loss and hypertension, 62 (41.3%) of the
age of 45-65 years. 150 patients with hearing loss individuals had hearing loss but no hypertension, 31
(incident cases) were obtained in the sequence of medical (20.7%) of the individuals did not had hearing loss but had
visits. Only sensory neural hearing loss patients were hypertension and 119 (79.3%) of the individuals neither
taken. 150 patients of control group who were living had hearing loss nor hypertension. There is a significant
nearby area of cases. The control group individuals were association between hypertension and hearing loss (p-
without hearing loss. Some individuals were with value < 0.0001) (Table 1).
hypertension and some were without hypertension. With
Table 1: Complete distribution of cases and controls
the help of pure tone audiometer (PTA) hearing patients
according to hypertension and hearing loss, BP>140/90.
were identified. The result, when plotted graphically is
called a pure tone audiogram. The instrument used for Hearing Loss
this is an electronic device called pure tone audiometer. It Yes No
consist of an audio-oscillator which generate pure tone Hypertension
Number
sounds of various frequencies usually at regular steps of Number of Percentage Percentage
of
Cases (%) (%)
125, 250, 500, 1000, 1500, 2000, 3000, 4000, 6000, 8000 controls
and 10,000Hz only. Each tone can be separately amplified Yes 88 58.7 31 20.7
to a maximum of 100 or 110 dB in most frequencies No 62 41.3 119 79.3
except the very low and very high frequencies where the
Total 150 100 150 100
range is slightly lesser. The tones are attenuated by an
attenuator dial which is marked in decibels (dB) and The number of individuals in the age groups 45-50 years
graduated in 5 decibel steps from -10 to 110 dB. The who had both hypertension (HTN) and hearing loss (HL)
audiometer is connected to standard and specified was 14 (15.9%). In the age group 51-55 years who had
earphones or to a bone conduction vibrator through both hearing loss and hypertension was 13 (14.8%) and in
which the sound is presented to the subjects ear. The the age group 56-60 years who had both hearing loss and
audiometer is operated by means of a noiseless switch hypertension was 27 (30.7%). In the age group 61-65
called interrupter which can introduce or interrupt a years who had both hearing loss and hypertension was 34
tone. PTA only measures thresholds, rather than other (38.6%). The higher age group 61-65 years were
aspects of hearing such as sound localization. However, significantly affected with hypertension and hearing loss
there are benefits of using PTA over other forms of the lower age groups. ( p-value< 0.001) (Table 2).
hearing test, such as click auditory brainstem response.
PTA provides ear specific thresholds, and uses frequency Table 2: Age distribution of individuals with both hearing
specific pure tones to give place specific responses, so loss and hypertension
that the configuration of a hearing loss can be identified. No. of cases with Percentage of both
As PTA uses both air and bone conduction audiometry, Age
both HTN and HL HTN and HL (%)
the type of loss can also be identified via the air-bone
45-50 years 14 15.9
gap. Conventional audiometry tests frequencies between
250 hertz (Hz) and 8 kHz, whereas high frequency 51-55 years 13 14.8
audiometry tests in the region of 8 kHz-20 kHz. Some 56-60 years 27 30.7
environmental factors, such as ototoxic medication and
61-65 years 34 38.6
noise exposure, appear to be more detrimental to high
frequency sensitivity than to that of mid or low
The number of males in the age group 45-50 years with
frequencies. Therefore, high frequency audiometry is an
hearing loss and hypertension were 8 (15.6%). The
effective method of monitoring losses that are suspected
number of males in the age group 51-55 years with
to have been caused by these factors. It is also effective in
hearing loss and hypertension were 7 (13.8%). The
detecting the auditory sensitivity changes that occur with
number of males in the age group 56-60 years with
ageing. With questioner discussion of patients the data of hearing loss and hypertension were 18 (35.3%). The
age, gender, schooling, weight, height, and arterial number of males in the age group 61-64 years with
pressure were maintained. All the data generated from
hearing loss and hypertension were 18(35.3%). The higher
the patients were statistically analyzed in the excel
age group males were significantly affected with hearing
Microsoft office 2007.
International Journal of Pharmaceutical Sciences Review and Research
Available online at www.globalresearchonline.net 310
Copyright protected. Unauthorised republication, reproduction, distribution, dissemination and copying of this document in whole or in part is strictly prohibited. Copyright pro
Int. J. Pharm. Sci. Rev. Res., 29(1), November December 2014; Article No. 56, Pages: 309-313 ISSN 0976 044X

loss and hypertension than lower age group with p-value< Table 6: Distribution of individuals not taking
0.002 (Table 3). antihypertensive medications
Table 3: Age distribution of males with both hypertension Individuals not Percentage (%) of
and hearing loss Hypertensive No. of taking anti- individuals not taking
individuals individuals hypertensive anti-hypertensive
Age No. of males Percentage (%) medications medication

45-50 years Cases 88 10 11.3

8 15.6
Controls 31 2 6.5
51-55 years 7 13.8
Total 119 12 10.2
56-60 years 18 35.3
DISCUSSION
61-65 years 18 35.3
The present study showed the existence of an association
The table shows that the number of males with both between hearing loss and arterial hypertension in
hearing loss and hypertension were 51 (58%) and the individual between 45 and 65 years. Such associations
number of females with both hearing loss and between hearing loss and arterial hypertension has been
hypertension were 37 (42%). There were significantly an important object of research of Lucianalozza de
more number of males than females with hypertension moraes Marchiori et al (2006).3 This is also in accordance
and hearing loss p-value< 0.0001 (Table 4). 4
with the report of Rosen et al and Hansen et al and Maria
Table 4: Sex distribution of cases with hearing loss and Fernanda et al (2009). While Amstutz et al (1999)6and
5

hypertension Baraldi GS et al (2004)7 deny this association and even

present different result in the studies carried at distinct
Total No. of No. of cases with Percentage times. As to the methodological characteristics of this
Sex
cases HTN and HL (%) study the care taken in outlining the age factor, focusing
Male 83 51 58 on the age range of middle aged individuals between 45
Female 67 37 42 and 65 years as they do in hypertension investigations,
(Antikainen RL et al(1998, 2000)8 the strict exclusion
Total 150 88 100 criteria, eliminating individuals with the diseases and
The number of females with both hearing loss and specific activities capable of producing hearing alterations
hypertension in the age group 45-50 years is 6 (16.2%) and care taken in diagnosing their hearing loss and
which was also same for the age group 51-55 years. The arterial hypertension certainly helped to reduce selection
number of females with both hearing loss and biases. Pertaining to the statistical analysis it was found
hypertension in age group 56-60 years was 9 (24.3%). The out that there was a significant association between
number of females with both hearing loss and hearing loss and hypertension (p =0 .0001). This present
hypertension in the age group 61-65 years was 16 study was non-paired case control study and was done by
(43.5%). The higher age groups of females were SPSS version 17, odds ratio = 5.45. This means that
significantly affected more with hearing loss and individuals having hypertension are five times more risk
hypertension than the lower age groups (p value< 0.0001) for developing hearing loss than normotensive
(Table 5). individuals. This is in accordance to Luciana lozza de
moraes Marchiori et al (2006) 3. With ageing, there is
Table 5: Age distribution of females with both hearing higher number of chronic diseases. Systemic arterial
loss and hypertension among cases hypertension and hearing loss have important prevalence
in the elderly population according to Baraldi GS et al
No. of females 7
Age Percentage (%) (2004). In this study we observed that although the
with HTN and HL
sample individuals were between 45 and 65 years (middle
45-50 years 6 16.2
age) the higher age group proved to be an independent
51-55 years 6 16.2 risk factor for hearing loss(p-value < 0.001). This is
56-60 years 9 24.3 probably due to the fact that as we all know, with age
61-65 years 16 43.5
there are structural alteration in the whole body,
including the hearing system which is in accordance with
Among the 88 cases with hypertension, only 10 (11.3%) ASHA (American- Speech- Language- Hearing
did not use medications. Among the 31 control group Association, 2004).1 Despite these structural changes
with hypertension only 2(6.5%) did not use medication. caused by age, Pedalini MEB et al (1997)9 and Otaviani et
Among the total 119 individual with hypertension only al (1998)10 mention presbyacusia, which usually start at
12(10.2%) did not use anti-hypertensive medication around 65 years of age and is a hearing loss type accruing
(Table 6). from ageing itself and is associated to specific audiologic
characteristics being a descending, bilateral and
symmetrical sensorineural hearing loss type.

International Journal of Pharmaceutical Sciences Review and Research

Available online at www.globalresearchonline.net 311
Copyright protected. Unauthorised republication, reproduction, distribution, dissemination and copying of this document in whole or in part is strictly prohibited. Copyright pro
Int. J. Pharm. Sci. Rev. Res., 29(1), November December 2014; Article No. 56, Pages: 309-313
11
According to Rarey KE et al (1996) in the experimental
study using rats with arterial hypertension, it was noted
that hypertension is an important risk factor for age-
related hearing loss with ageing. The hypertensive
animals had a higher action potential threshold, a higher
electro chemical potential happened only in the
extremely aged animals, while potassium concentration
increased not only in the endolymphatic cells, but also in
the perilymphatic ones. These data help us understand
hearing loss in hypertensive individuals. According to
Marchiori L L M et al(2003)12 and Collet L et al (1992)13 the
environment factors such as noise, inhalation of toxic
substances, certain metabolic and circulatory alteration,
infections and genetic inheritance, may also influence the
individuals hearing, often times accelerating the process
of cochlear degeneration. As to gender, there was a
difference in the men to women ratio in both groups, due
to fact it was not a pair sample. Cases were taken at
random, during regular medical visits, while the control
groups were selected by the individuals staying nearby
places of hearing loss patients. Greater number of men
was taken because of hearing impairment suspicion. In
this study in the cases group among hypertension and
hearing loss, men were significantly affected more than
women (p-value< 0.0001).
As per Dubno JR et al (1997)14 after a study that
correlated age, gender and hearing acuity for spoken
word, reported that males had a significant age related
drop in their hearing acuity and speech recognition, while
women did not show such pattern. This corroborates with
the present study. Pearson et al (1995)15 after a
longitudinal study involving 681 men and 416 women,
without signs of specific hearing disorders, unilateral or
noise-induced hearing loss, reported that there is a two
fold increase in the speed at which men lose their
hearing, when compared to women, showing that age
and gender are indeed related to hearing loss even in
groups without signs of noise-induced hearing loss which
is in accordance with the present study. According to
13
Collet et al (1992) after studying the influence of age
and gender, reported that it was possible to determine a
correlation with hearing. In the present study, carried out
with male individuals with ages varying between 45 and
65 years among cases, the male gender proved to be an
independent risk factor for hearing loss. This corroborates
the studies that have reported a significant drop in
hearing acuity for male individuals as they age. (Dubno JR
et al (1997)14 Pearson et al (1995)15 and Collet et al
1992.13 The care related to arterial hypertension and
hearing loss will certainly serve to avoid the frustrations
caused by the reduction in ones capacity to understand
oral language caused by a reduction in hearing acuity, as
16 17
per Ferreira DR et al (2004) , Tambs K et al (2004) and
18
Marques et al (2004) which may happen to arterial
hypertensive patients.
10.
International Journal of Pharmaceutical Sciences Review and Research
Available online at www.globalresearchonline.net
Copyright protected. Unauthorised republication, reproduction, distribution, dissemination and copying of this document in whole or in part is strictly prohibited.
ISSN 0976 044X
CONCLUSION
In this study we found that the incidence of hearing loss
and hypertension in more in higher age group i.e. 61-65
years. Increased incidence of hearing loss and
hypertension is significantly more in males than in
females among cases. The present study shows that there
is a very significant association between hearing loss and
hypertension. By this study we conclude that patients
having hypertension will have five times risk of
developing hearing loss than a normal person without
hypertension. Since the study has shown that arterial
hypertension is an independent risk factor for hearing
loss, beside the male gender and advanced age, it is to
highlight that may mitigate the mechanism that cause
degeneration of hearing apparatus caused by circulatory
problems most specifically high blood pressure. Therefore
the result in this research, through evidence of
association between arterial hypertension and hearing
loss, can allow for an integrated work of cardiologist,
nephrologist, otolaryngologist, audiologist and other
health professionals concerned with alteration caused by
arterial hypertension.
Acknowledgement: Authors are grateful to Er. G B Kar
and Prof. Dr. D K Roy for extended facility in the research.
Authors would like to thank Mr. P K Bramha, Dr. Lipilekha
Patnaik, Mrs Lopamudra Tripathy for constantly help
during the study.
REFERENCES
1. ASHA (American Speech - Language - Hearing Association).
Disponvelem http://www.asha.org/Acessoem 29/10/2004
2. Katz J. Tratado A. So Paulo: Manole, 1989.
3. Luciana LM, Eduardo AR, Tiemi M, Hypertension as a factor
associated with hearing loss, Rev. Bras, 72, 2006, 25-29.
4. Rosen S, Presbycusis Study of a Relatively Noise-free
Population in the Sudan, Ann Otol, 71, 1962, 727.
5. Markov M, The cocheovestibular syndrome in
hypertension, CeskOtolaryngol, 39(2), 1990, 89-97.
6. Amstutz-Montadert I, Andrieu-Guitrancourt J,
Snescenceet sardine, Aging and deafness. Rev Prat, 50(2),
2000, 161-164.
7. Baraldi GS, Almeida LC, Borgea ACLC, Hearing loss and
hypertension: findings in an older by group, Rev Bras
Otorrinolaringol, 70(5), 2004, 640-4.
8. Antikainen RL, Jousilahti, P, Tuomilehto J, Systolic blood
pressure, isolated systolic hypertension and risk of
coronary heart disease, strokes, cardiovascular disease and
all-cause mortality in the middle-aged population, J
Hypertens, 16(5), 1998, 577-583.
9. Pedalini MEB, Liberman PHP, Pirana S, Jacob WF, Camara J,
Miniti A, Anlise do PerfilAudiolgico de idososatravs de
funoauditivaperifricae central. Rev Bras Orl, 63(5), 1997,
489-496.
Otaviani F, Presbycusis ActaOtorhinolaryngolItal, 18(4
Suppl 59)74, 1998, 77.
312
Copyright pro
 Int. J. Pharm. Sci. Rev. Res., 29(1), November December 2014; Article No. 56, Pages: 309-313 ISSN 0976 044X

11. Rarrey KE, MA Y L, Gerhardt KJ, Fregly MJ, Garg LC, Rybak 15. Pearson JD, Morrell CH, Gordon-Salant S, Brant LJ, Metter
LP, Correlative evidence of hypertension and altered EJ, Klein LL, Fozard JL, Gender differences in a longitudinal
coclearmicrohomeostasis: electrophysiological changes in study of age-associated hearing loss, J AcoustSoc Am, 97(2),
the spontaneous hypertensive rats, Hearing Research, 102, 1995, 1196-205.
1996, 63-69.
16. Ferreira DR, Silva AA, Aging and life quality: An
12. Marchiori LLM, Gibrin PCD, Diabetes mellitus: prevalence of otorhinolaryngological review. Rev LaryngolOtolRhinol,
hearing disorders. Arq Bras EndocrinolMetab, 47, 2003, 82- 125(3), 2004, 143-50.
86.
17. Tambs K, Moderate Effects of Hearing Loss on Mental
13. Collet L, Berger-Vachon C, Desreux V, Morgon A, Auditory Health and Subjective Well-Being: Results from the Nord-
brainstem response (ABR) latency: relative importance of Trondelag Hearing Loss Study, Psychosom Med, 66(5),
age, sex and sensorineural hearing-loss using a 2004, 776-82.
mathematical model of the audiogram, Int J Neurosci, 67(1-
18. Marques ACO, Kozlowski L, Marques JM,
4), 1992, 187-197.
Reabilitaoauditiva no idoso/ Auditory rehabilitation in
14. Dubno JR, Lee FS, Matthews LJ, Mills JH, Age-related and the elderly.
gender-related changes in monaural speech recognition, J
Speech Lang Hear Res, 40(2), 1997, 444-452.

Source of Support: Nil, Conflict of Interest: None.

International Journal of Pharmaceutical Sciences Review and Research

Available online at www.globalresearchonline.net 313
Copyright protected. Unauthorised republication, reproduction, distribution, dissemination and copying of this document in whole or in part is strictly prohibited. Copyright pro